Ovarian Serous Tumors of Low Malignant Potential with Nodal Low Grade Serous Carcinoma.
Bojana Djordjevic, Anais Malpica. University of Ottawa, ON, Canada; M.D. Anderson Cancer Center, Houston, TX
Background: Serous tumors of low malignant potential (SLMPs) and low-grade serous carcinoma (LGSC) are part of one biological continuum, whereby SLMP can transform into LGSC. In up to 22% of ovarian SLMPs with lymph node (LN) involvement, LNs are the only site of extra-ovarian disease. We and others have suggested that some nodal SLMPs arise from nodal endosalpingiosis and evolve independently in LNs, rather than being related to the ovarian primary. Furthermore, some cases of ovarian SLMP have been associated with nodal LGSC, which could result from a similar pathogenetic mechanism. This is the first clinicopathologic study of 5 such cases.
Design: We identified 5 cases in the MD Anderson Cancer Center pathology database with ovarian SLMP and nodal LGSC. Clinical follow-up was obtained from chart review. Pathology reports and slides were reviewed to confirm the diagnosis of pure ovarian SLMP and record the location of lymph nodes with endosalpingiosis, SLMP and LGSC.
Results: The patients ranged from 28-68 years in age (median 32). LGSC was identified in supraclavicular (2), cervical (1), periaortic (1) and intramammary (1) LNs, either preceding (by 7 months), concurrently, or following (up to 24 months) the diagnosis of ovarian SLMP. In 3 cases, pelvic and periaortic LNs were collected during the ovarian tumor resection, with nodal SLMP and endosalpingiosis identified in 3 and 2 cases respectively. In the remaining 2 cases, lymph node dissection was not performed. All except one patient received adjuvant platinum-based therapy. Follow up ranged from 1 to 20 years (average 7 years). None of the patients recurred in the pelvis. 3 patients are free of disease. However, one patient with cervical nodal LGSC developed brain metastases and died. Another patient with supraclavicular nodal LGCS is currently living with bilateral malignant pleural effusions. Both patients had pelvic/periaortic nodal SLMP and extensive nodal endosalpingiosis.
Conclusions: For the first time, we present a case series of patients with ovarian SLMP and nodal LGSC. Despite no evidence of LGSC in the pelvis, or any pelvic recurrences, the patients developed extrapelvic nodal LGSC. These patients also had nodal endosalpingiosis and SLMP, suggesting that SLMP/LGSC tumors in LNs may arise independently of the ovarian primary, progress along their own timeline and undergo metastatic spread. Therefore, in patients with ovarian SLMP and extensive pelvic/periaortic nodal SLMP and/or endosalpingiosis, examination and follow-up of extrapelvic LNs is warranted.
Category: Gynecologic & Obstetrics
Monday, February 28, 2011 8:15 AM
Platform Session: Section D, Monday Morning